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Mindfulness Based

Stress Reduction and

Chronic Pain

AgendaAgenda

• Introductions

• Chronic Pain

• Mindfulness-based Stress

Reduction and Research

• What is mindfulness?

• Experiential learning and

dialogue

– Questions and ways forward

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Descending Inhibitory PathwayDescending Inhibitory Pathway

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Mindfulness-Based Stress Reduction

(MBSR)

Mindfulness-Based Stress Reduction

(MBSR)

Stress Reduction Clinic,

UMASS Medical Center,

established 1979

• 8-week program, 2 hours

per week, plus a full day

of practice

• Educational, not

therapeutic orientation

What is Mindfulness-Based

Stress Reduction?

What is Mindfulness-Based

Stress Reduction?

• Offered at >700 medical centers in

U.S. and around the world

• 35+ years of research in a wide

range of chronic clinical ailments

• Has its own journal for new studies

in the area

Categories of MindfulnessCategories of Mindfulness

• Vipassana Meditation originating in

ancient Buddhist Traditions over 2 millennia ago

• Mindfulness Based Stress Reduction

• Mindfulness Based Cognitive Therapy

• Mindfulness Based Eating

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MBSR and ResearchMBSR and Research

Research GrowingResearch Growing

University of TorontoUniversity of Toronto

• MBCT is as effective as anti depressants in preventing

relapse from clinical

depression (Segal and Teasdale, 2000)

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MBSR and PainMBSR and Pain

• Zeidan, Martucci, Kraft, Gordon, McHaffie

and Coghill, 2011

• Meditation reduced all subjects pain

intensity by 11-70%

• Meditation reduced all subjects

unpleasantness rating 20-93%

Pain Relief Pain Relief

• Meditation modulates pain through several

brain mechanisms

• The first ….

• Meditation significantly reduced pain

related afferent processing

Limbic SystemLimbic System

• Primitive system

• Contains the amygdala and the thalamus

• Responsible for our emotional responses to situations in our lives

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ThalamusThalamus

• Widespread deactivation of thalamus

during meditation

• Filtering mechanism of ascending sensory

information at the thalamic level

• Operates as a gatekeeper between the

thalamus and the cortex

• The second…

• Mindfulness meditation pain relief

was directly related to brain regions

associated with the cognitive

processing of pain

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Morone, Greco and Weiner, 2007Morone, Greco and Weiner, 2007

• Compared MBSR group with a control

• MBSR group displayed significant

improvements in Chronic Pain Acceptance

Questionnaire – Total score and Activities engagement sub scale

• Improved physical function

Kerr et al, 2011Kerr et al, 2011

• Mindfulness meditation can significantly

increase anticipatory alpha modulation (7-14 Hz)

• Changes in alpha rhythm has been associated with enhanced filtering of

inputs to the primary sensory cortex

• Alpha modulation thought to play an active

role in gating thalamocortical sensory

transmission

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What is Mindfulness?What is Mindfulness?

Awareness is

Continuous

Awareness is

Continuous• The “triangle” of awareness:

• Body sensations

• Thoughts

• Emotions

• But we don’t always bring attention to

our awareness

• Much of the day, we’re on autopilot

• Attending to the body/breath brings us into the present moment —

immediately

Autopilot….Autopilot….

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Mindfulness Begins

With Attention

Mindfulness Begins

With Attention• Jon Kabat-Zinn defines

mindfulness as attention

that is:

• Intentional

• Moment-to-moment

• Non-judgmental

• Paying attention

• On purpose

• In a particular way

• Non judgmental attention to present

moment experience

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Interwoven aspects of a cyclic

process

Interwoven aspects of a cyclic

process

• Intention

• Attention

• Attitude

AttentionAttention• Observing moment by moment

experience

• A return to things in

themselves

• Attending to the contents of

our consciousness, moment by moment

AttitudesAttitudes• Acceptance

• Nonjudging

• Openness

• Curiosity

• Trust

• Kindness

• Nonstriving

• Patience

• Letting go

• Gentleness

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What happens in

Mindfulness

What happens in

Mindfulness

• A shift in perspective

• Through meditation practice, intentionally paying attention

with acceptance and openness

(attitude) we experience a shift in perspective.

Re perceivingRe perceiving

• A shift in perspective

Re perceivingRe perceiving• Rotation of consciousness

• Disidentify with the contents of consciousness and able to see

freshly with objectivity and clarity

• Rather than be immersed in the drama of our story, we are able to stand back and witness it

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• The phenomena contemplated are

distinct from the mind contemplating

them

• Daniel Goleman

Dis identify with contents

of consciousness

Dis identify with contents

of consciousness

• Reperceiving enables us to make what was the subject “my pain”, “ my depression” into the object

• We realize that if I can see it I must be more than just it

• Dis-identify with the contents of mind

• .

ResourcesResources

• MBSR British Columbia

www.mbsr.bc.ca

• Center for Mindfulness in Medicine, Health Care and Society

http://www.umassmed.edu/cfm/index.aspx

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References References

• Kabat-Zinn (1990). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness, Dell Publishing, New York, New York.

• Kabat-Zinn (1994). Wherever You Go, There You Are. Hyperion, New York.

• Kerr, C., Jones, S., Wan, Q., Pritchett, D., Wasserman, R., Wexler, A., Villanueva, J., Shaw, J., Lazar, S., Kaptchuk, T., Littenberg, R., Hamalainen, M., Moore, C. (2011).Effects of mindfulness meditation training on anticipatory alpha modulation in primary somatosensory cotex, Brain Research Bulletin, 10, 1016

References ContinuedReferences Continued

• Desbirdesm G., Negi, L., Pace, T., Wallace, A. Raison, C. & Schwartz, E. (2012). Effects of mindful-attention and compassion meditation training on amygdala response to emotional stimuli in an ordinary, non-meditative state. Frontiers in Human Neuroscience, 8, 292, 1-15

• Farb, N., Andersen, A., Segal, Z. (2012) The Mindful Brain and Emotion Regulation in Mood Disorders. Canadian Journal of Psychiatry. 57(2), 70-77

References ContinuedReferences Continued

• Morone, N., Greco, C., Weiner, D. (2007) Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study, Pain 04, 038

• Ricard, M., Lutz, A., Davidson, R. ( 2014) The neuroscience of meditation, Scientific American, November

• Zeidan, F., Martucci, K., Kraft, R., Gordon, N., McHaffie, J., Coghill, R.(2011). Brain Mechanisms Supporting the Modulation of Pain by Mindfulness Meditation, The Journal of Neuroscience, 31(14), 5540 - 5548

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“Compared to what we ought to be, we are only half awake.”

…William James